RN Prior Authorization Lead

Job Description

RN Prior Authorization Lead

The Prior Authorization Lead oversees the daily operations of the Prior Authorization team by coordinating workflow, monitoring productivity, providing staff training, resolving complex authorization issues, and serving as the subject matter expert for payer requirements. This position partners with clinic leadership, providers, revenue cycle departments, and payers to ensure authorizations are obtained accurately and timely, minimizing delays in patient care and reducing authorization‑related denials.

Hours:

Full‑time – 40 hours per week

Required:

ADN or RN (RN – Registered Nurse, Illinois Department of Financial and Professional Regulation)

• Assist with onboarding, training, mentoring and ongoing education of staff.
• Collaborate with Revenue Cycle departments to reduce authorization‑related claim denials.
• Develop and maintain standardized authorization workflows and reference materials.
• Escalate urgent or complex authorization issues to leadership and providers as needed.
• Identify trends impacting reimbursement and develop corrective action plans.
• Perform quality audits and provide feedback to staff.
• Promote a collaborative, patient‑centered team environment.
• Provide day‑to‑day leadership and guidance to the Prior Authorization Team.
• Stay current on payer policy changes and communicate updates to the team.

ADN or RN (Registered Nurse, Illinois Department of Financial and Professional Regulation).

Minimum education:

ADN; preferred: RN.

Estimated hourly compensation range: $30.56 – $47.37, based on experience.

• Career development through continuing education and on‑site training.
• On‑site classroom learning programs.
• Internet courses.
• Generous tuition reimbursement program.